How is the penis anatomy and structure?
The penis, which is a male sexual organ, has a body, glans, and skin covering it. A thick, elastic membrane lies underneath the skin, shielding the internal structures. On the inside of the penis, there are 3 structures similar to pipes or long tubes. The lower part of them (the long line facing the testicles) is a spongy structure that serves as a canal for the discharge of urine and semen. This canal opens to the prostate and then to the bladder. Two more tubes are mounted side by side on top of this tube. These have a rich-blood vessel structure. During an erection (hard-on), the blood flow from these vessels increases rapidly and these tubes fill with blood. The mouths of the vessels carrying the blood back are closed at this moment, trapping the blood in these channels, which inflate like balloons with blood and therefore provide erection.
What does the erectile dysfunction mean and what are its causes?
Erectile dysfunction is defined as the inability of the penis to reach the level of hardness required for successful sexual intercourse or to sustain this level of hardness during intercourse (premature softening). This may be a continuous situation, as well as it may be occasional. This condition in medicine is called Erectile Dysfunction.
A healthy erection (hard-on) is a complex event that involves the coordinated action of nerves from the brain and spinal cord, hormones in the body, and blood vessels. Therefore, if there is a problem in any of the structures involved in this function, the problem of erection occurs. At the same time, an ideational, tactile, visual, or auditory stimulus is required for an erection. Problems in these stimuli or mentality also cause erection problems.
Therefore, we can divide erection problems into 3 main topics;
- Psychological reasons
- Organic reasons
- Mixed type, the combination of both psychological and organic problems
Some of the organic reasons are as follows: Penile veins problem (aortic stenosis, venous leak). Diseases affecting the nerves to the penis; Diabetes, brain diseases, spinal cord diseases, prostate or nerve damage caused by surgeries performed in this region, and radiation therapy. Hormonal problems (testosterone deficiency, excess prolactin, thyroid hormone problem), systemic diseases (hypertension, liver failure, kidney failure, cancers, etc.), problems in the structure of the penis (Peyronie’s plaque), and so on.
How is Erectile Dysfunction diagnosed?
The first step in making a diagnosis is taking a comprehensive medical history and doing a thorough physical examination on the patient. The patient’s medical history especially helps us in learning whether the patient can have sexual intercourse, the habits and frequency of sexual intercourse, and the pleasure he/she gets from sexual intercourse. Apart from that, some questions are asked to determine if there is an organic issue mentioned above. Again, in the examination of the patient, it is checked whether there is any problem in the penis and testicles.
There is an internationally accepted query form in which we question the sexual habits of the patients. Scoring is done by filling out this form and the degree of the patient’s erection problem is tried to be determined.
Following this section, some blood tests should be performed. These include certain hormones, liver and kidney function, cholesterol level, and blood count. If there are urinary complaints, urine analysis is required.
Penile Color Doppler Ultrasonography, now known as Color Ultrasound and performed on the penis as imaging (radiological) technique, is extremely helpful in determining whether or not there is an organic problem.
Another test is based on monitoring the patient by sleeping during the night in an observation room. This test involves attaching several sensing devices to the penis, and calculating how many times and for how long erections occur during the night. This method, however, is not widely used.
What is the treatment for Erectile Dysfunction?
In order to make a treatment decision, first of all, the cause of erectile dysfunction should be determined. If the root of the problem can be removed, the problem can be resolved. However, it is not possible to eliminate some of the diseases that cause this (such as Diabetes), in this case, it may be necessary to do one of the treatments listed below.
- a) Lifestyle changes: Patients with minor complaints should overcome or reduce their problems by making a few lifestyle changes.
– Increasing daily physical activity
– Prevention of obesity
Increasing nutrition with the Mediterranean diet (fruit, vegetable, grain, and olive oil-based diet)
⁃ Quitting smoking
⁃ Keeping blood sugar level in control in diabetic patients
⁃ Keeping blood pressure (hypertension) regular
– Prevention of depression
– Frequent and regular sexual intercourse
– It is thought that cycling for a long time can have a detrimental effect.
- b) Drug therapy: The biggest mistake made in this regard is the use of erection drugs from the pharmacy without the consulting a doctor. There are many patients who apply to the urology outpatient clinic with erectile dysfunction and unaware of diabetes. Taking this complaint to the doctor can not only fix the problem, but it can also expose a much more serious and life-threatening underlying disease. Drug therapy should begin at the appropriate dosage and time after a clear diagnosis of the disease has been identified.
- b) Vacuum device: Vacuum devices consist of a plastic cylinder, vacuum pump, and elastic compression band. A lubricant product is applied to the penis. The penis is inserted into the cylinder
Air is pumped out of the cylinder. Thus, a vacuum effect is created and erection occurs.
The compression band at the free end of the cylinder is placed on the root of the erected penis. Thus, the continuation of the hardness level is ensured. The cylinder is separated from the penis. The compression band can stay on the penis for half an hour. The band maintains the erection until it is removed. Its use has decreased significantly with the introduction of oral drugs.
- c) Self injection: It is a method that can be applied to patients who do not benefit from tablet therapy. A drug mixture is prepared by the doctor and given to the patient in an iv bag. The patient takes the described amount of medicine into the injector and injects his own penis. However, this application is both difficult and should be used very carefully as it may cause penile damage problems due to permanent erections.
- d) Surgery (Surgical treatment): Surgical treatment is the treatment for patients who do not benefit from drug treatments or who do not want to use or cannot use drugs. In surgical treatment, penile implants are placed inside the penis to provide an erection. Meanwhile, if there are any penile curvatures or plaques, they are treated as well. These devices are placed in blood-filled tubes to ensure erection in the internal structure of the penis as described in the first question. There are several types of penile implants. These are roughly divided into two; flexable and inflatable implants.
⁃ One-piece penile implant: These types of implants are called flexible implants. A rigid pair of sticks are inserted into the penis. Following the recovery, the patient straightens the penis while having intercourse, and after the intercourse, the penis can be bent and the underwear can be dressed.
⁃ Two-piece penile implant: It is an inflatable penile implant. Two inflatable balloons are placed inside the tubes in the penis. There is a water pump attached to the end of these balloons. This pump is placed in the yolk sac next to the testicles in a way that is not visible from the outside. When the patient will have intercourse, he performs the penis erection by pressing this pump. At the end of the intercourse, it makes the penis normal with the help of the pump.
⁃ Three-piece penile implant: This is an inflatable implant type. The difference of this from the two-piece is that the water reservoir is placed next to the urinary bladder under the belly, not the yolk sac. Water is transported from this reservoir to the balloon inside the penis through a mechanism with a button located next to the testicles. Patient comfort is better because the mechanism located next to the testicle is smaller than the two-piece.